Lung imaging characteristics in a patient infected with Elizabethkingia miricola following cerebral hemorrhage surgery: A case report

BACKGROUND Elizabethkingia miricola is a non-fermenting gram-negative bacterium,which was first isolated from the condensate of the Russian peace space station in 2003.Most studies on this bacterium have been carried out in the laboratory,and clinical case studies are rare.To date,a total of 6 clinical cases have been reported worldwide.CASE SUMMARY We present the first case of postoperative pulmonary infection in a patient with intracerebral hemorrhage due to Elizabethkingia miricola.The imaging character-istics of pulmonary infection were identified and the formulation and selection of the clinical treatment plan for this patient are discussed.CONCLUSION Elizabethkingia miricola infection is rare.When pulmonary infection occurs,computed tomography imaging may show diffuse distribution of a ground glass density shadow in both lungs,the air containing bronchial sign in local areas,thickening of bronchial vascular bundle,and pleural effusion.

Value of inflammatory mediator profiles and procalcitonin in predicting postoperative infection in patients with hypertensive cerebral hemorrhage

BACKGROUND Hypertensive cerebral hemorrhage(HICH)is a common clinical cerebrovascular disease and one of the most serious complications of hypertension.Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH.Changes in the levels of inflammatory mediators,which are closely related to the occurrence and development of postoperative infection,and procalcitonin(PCT),which is a sensitive indicator for diagnosing bacterial infections,are widely used in clinical practice.AIM To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.METHODS A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection(n=80)and non-infection(n=191)groups according to whether postoperative infection occurred.The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed.Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups,pre-and postoperatively.RESULTS A total of 109 strains of pathogenic bacteria were detected in the infection group,including 67 strains(61.47%)of gram-negative bacteria,32 strains(29.36%)of gram-positive bacteria,and 10 strains(9.17%)of fungi.The main infection site of the patients in the infection group was the respiratory system(63.75%).Preoperative interleukin(IL)-4,IL-6,IL-10,tumor necrosis factor-α,interferon-γ,and PCT levels were higher in the infection group than in the non-infection group(P<0.05),and there were no significant differences in the IL-2 Levels between the two groups(P>0.05).The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively(P<0.05),and were higher than those in the non-infection group(P<0.05).Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection(P<0.05).Operating characteristic curve analysis results showed that the area under the curve(AUC)values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824,respectively.The AUC value of joint detection was 0.866,which was significantly higher than that of the single index(P<0.05).CONCLUSION Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH.Their detection is clinically significant for early identification of patients at high risk for postoperative infection.

Nursing Care of a Case of Mediastinal Tumor Resection Combined with Postoperative Thoracic Hemorrhage after Video-assisted Thoracoscopic Surgery(VATS)

Objective: To summarize the nursing experience of a patient withpostoperative intrathoracic hemorrhage after thoracoscopic-assistedresection of the right upper mediastinal tumor through the original incision.Methods: Summarize the main points of nursing care of postoperativeintrathoracic hemorrhage after thoracoscopic mediastinal surgery, includingobservation and nursing when internal hemorrhage occurs after operation,respiratory management, activity management and pain managementmeasures. Result: After careful care, the patient recovered and dischargedsmoothly. Conclusion: It is particularly important to observe the overallobservation and take timely corresponding nursing measures for patientswith intrathoracic hemorrhage after thoracoscopic mediastinal surgery.

Primary and secondary postoperative hemorrhage in pediatric tonsillectomy

Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome.Postoperative hemorrhage of tonsillectomy is a lifethreatening complication.AIM To identify the risk factors that may contribute to primary and secondary postoperative hemorrhage in pediatric tonsillectomy.METHODS The clinical data from 5015 children,3443 males and 1572 females,aged 1.92-17.08 years,with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected.The variables including sex,age,time of onset,diagnosis,method of tonsillectomy,experience of surgeon,time when the surgery started and monthly average air temperature were abstracted.The patients with postoperative hemorrhage were classi
ed into two groups,the primary bleeding group and the secondary bleeding group,and their characteristics were compared with those of the nonbleeding group separately.Statistical analysis was performed by chi-square test with SPSS 20.RESULTS Ninety-two patients had post-tonsillectomy hemorrhage,and the incidence rate of post-tonsillectomy hemorrhage was 1.83%.The mean age was 5.75 years.Cases of primary hemorrhage accounted for approximately 33.70%(31/92),and cases of secondary hemorrhage occurred in 66.30%(61/92).The rate of reoperation for bleeding was 0.92%,and the rate of rehospitalization for bleeding was 0.88%in all patients.Multiple hemostasis surgery was performed in 6.52%(3/46)of patients.The method of tonsillectomy(coblation tonsillectomy)and experience of the surgeon(junior surgeon with less than 5 years of experience)were significantly associated with primary hemorrhage(χ^(2)=5.830,P=0.016,χ^(2)=6.621,P=0.010,respectively).Age(over 6 years old)and time of onset(more than a 1-year history)were significantly associated with secondary hemorrhage(χ^(2)=15.242,P=0.000,χ^(2)=4.293,P=0.038,respectively).There was no signi
cant difference in sex,diagnosis,time when the surgery started or monthly average air temperature.There was a signi
cant difference in the intervention measures between the primary bleeding group and the secondary bleeding group(χ^(2)=10.947,P=0.001).The lower pole and middle portion were the common bleeding sites,followed by the upper pole and palatoglossal arch.CONCLUSION The incidence rate of post-tonsillectomy hemorrhage is low.Coblation tonsillectomy and less than 5 years’experience of surgeon contribute to the tendency for primary hemorrhage.Age and time of onset are responsible for secondary hemorrhage.

Risk factors and managements of hemorrhage associated with pancreatic fistula after pancreaticoduodenectomy

BACKGROUND: Post-pancreaticoduodenectomy pancreatic fistula associated hemorrhage (PPFH) is one of the leading lethal complications. Our study was to analyze the risk factors and managements of hemorrhage associated with pancreatic fistula after pancreaticoduodenectomy, and to evaluate treatment options. METHOD: We analyzed 445 patients who underwent pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy and evaluated the relevance between clinical data and PPFH. RESULTS: The incidence of postoperative pancreatic fistula (POPF) was 27.42% (122/445), and the incidence of PPFH was 4.49% (20/445). Among the 20 patients with PPFH, 7 died and 13 were cured. Interventional angiographic therapy was performed for 10 patients and 5 were successfully treated. Relaparotomy was performed for 5 patients and 2 were successfully cured. Univariate logistic regression analysis indicated that several risk factors were related to PPFH: the nature of tumor (carcinoid/low-grade or high-grade malignancy), preoperative day 1. serum prealbumin, preoperative day 1 total bilirubin (TBIL), operative time, blood loss in the operation, operative method (vascular resection and revascularization), postoperative day 3 TBIL, biliary fistula, and the grade of POPF. The multivariate stepwise logistic regression analysis demonstrated that the nature of tumor and the grade of POPF were independently risk factors of PPFH. Receiver operating characteristic curve indicated that preoperative day 1 serum prealbumin level <173 mg/L and postoperative day 3 TBIL level.1.68.tmol/L were the risk factors of PPFH. CONCLUSIONS; The risk of PPFH was found to be increased with high potential malignancy and high grade of POPE Angiography-embolization is one of the major and effective therapies for PPFH. Extraluminal-intraluminal PPFH is more serious and needs more aggressive treatments.

Superselective transcatheter arterial embolization to control renal hemorrhage after partial nephrectomy for renal tumors:A report of 9 cases and a literature review

Objective:This study aimed to evaluate the efficacy and safety of selective arterial embolization for hemorrhage after renal surgery and to summarize the clinical experience.Materials and methods:A total of 9 patients underwent arterial embolization after partial nephrectomy from 2010 to 2018.Results:Technical success was achieved in all patients;however,3 patients underwent a secondary arterial embolization because of short-term re-hemorrhage or the co-occurrence of accessory renal arterial hemorrhage.No serious complications occurred during the follow-up.Conclusions:Superselective arterial embolization is an effective and minimally invasive treatment for hemorrhage after partial nephrectomy.To improve the success rate of surgery,attention should be paid to the evaluation of accessory renal arteries and the management of suspected bleeding arteries.

Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection

AIM To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection(ESD) and individual antithrombotic agents.METHODS A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy(DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period(during the first six days or thereafter), were analyzed using univariate and multivariate analyses.RESULTS The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male(P = 0.007), specimen size(P < 0.001), and antithrombotic agent used(P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy(HBT)(P = 0.002) and DAPT/multidrug combinations(P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group(P < 0.01). Bleeding within postoperative day(POD) 6 was significantly higher in warfarin(P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations(P = 0.007). No thromboembolic events were reported.CONCLUSION We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.

Clinical Experience Sharing Of 218 Cases without Hemorrhage after Procedure for Prolapse and Hemorrhoids

Objective:To summarize the experience without hemorrhage after PPH of 218 patients with mixed hemorrhoid.Methods:PPH(Procedure for prolapse and hemorrhoids)was performed routinely.During operation,it is paid attention that the hemorrhoid artery should be completely mutilated,the anastomat should be squeezed before and after the anastomosis,the anastomosis should be carefully examined,the hemostasis should be completely performed,and relevant hemostasis measures should be taken after the operation.Results:None of the 218 patients had postoperative hemorrhage.Conclusion:Relevant measures can be taken after operation to prevent the occurrence of postoperative hemorrhage.

Efficacy of Postoperative Adjuvant Chemotherapy According to Prognostic Factor in Patients with Stage III Colon Cancer

Background: We retrospectively identified prognostic factors in patients with Stage III colon cancer and considered the effectiveness of postoperative adjuvant chemotherapy based on these prognostic factors. Methods: Two hundred and thirty four patients with lymph node metastases who underwent curative surgery for colon cancer between 1999 and 2005 were enrolled in the present study. Firstly, clinicopathological factors and survival data, were analyzed to determine prognostic factors related to cancer-specific survival. Secondly, we examined the effectiveness of postoperative adjuvant chemotherapy based upon these prognostic factors. Results: The multivariate analysis revealed that differentiation (P = 0.03, Hazard ratio = 2.50), lymphatic invasion (P = 0.02, Hazard ratio = 3.23) and the TNM classification, 7th?edition (P = 0.04, Hazard ratio = 1.94) were found to be significant independent prognostic factors. Among the patients classified as TNM IIIA, the recurrence-free survival rates were extremely good. Among the patients classified as IIIB and IIIC, there was no significant difference between the patients with and without postoperative adjuvant chemotherapy. Conclusion: The present study suggests that the patients with Stage IIIA colon cancer may not require postoperative adjuvant chemotherapy. The addition of oxaliplatin to 5-FU should be considered for the patients with Stage IIIB and IIIC colon cancer, for whom the prognoses are far from satisfactory.

Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery

AIM:To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.METHODS:This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography,and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization.RESULTS:Angiography showed that a discrete bleeding focus was detected in 21(81%) of 26 patients.Positive angiographic findings included extravasations of contrast medium(n = 9),pseudoaneurysms(n =9),and fusiform aneurysms(n = 3). Transarterial embolization was technically successful in 21(95%) of 22patients. Clinical success was achieved in 18(82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding.CONCLUSION:The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.

Progress in Analgesic-Sedative Treatment in Perioperative Period of Hypertensive Intracerebral Hemorrhage

Hypertensive intracerebral hemorrhage (HICH) refers to intra cerebral hemorrhage at basal ganglia, thalamus, ventricle, cerebellum and brainstem in patients with history of explicit hypertension disease, excluding secondary cerebral hemorrhage caused by trauma, vascular structural disorders, coagulation disorders, hematologic diseases, systematic diseases and neoplastic diseases. HICH is characteristic of high morbidity, fatality rate, disability rate and recurrence rate. HICH is the most common type of spontaneous cerebral hemorrhage and various surgical interventions are one of the major treatments for HICH. Surgical treatment is to eliminate hematoma, relieve oppression of hematoma on surrounding brain tissues, lower intracranial pressure and alleviate secondary brain tissue damages, thus enabling to decrease fatality rate of patients and improve the long-term quality of life. Patients with HICH often may have different degrees of coma, pains, dysphoria, anxiety and delirium in the postoperative period. After central pivot was damaged, the sympathetic central excitability spreading is strengthened in the state of cortical inhibition, which also might be accompanied by paroxysmal sympathetic hyperexcitation syndrome to strengthen disease conditions of patients and thereby influence subsequent treatment. Several professional guidelines all recommend analgesic-sedative treatment as an important component of ICU therapy. However, it lacks support by large sample sized clinical research results of analgesic-sedative treatment of HICH in the postoperative period. This study analyzed literature concerning analgesic-sedative treatment of HICH in the postoperative period in recent years, aiming to guide specific clinical implementation.

Time Course of Postoperative Complications in Low-Risk Women after Planned Cesarean Section

Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.

Sevoflurane Preconditioning and Total Knee Arthroplasty Bleeding: Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.

Analysis and treatment of delayed hemorrhage after partial nephrectomy

Objective: To explore the causes of delayed hemorrhage after partial nephrectomy and its prevention and treatment methods. Methods: Clinical data for 64 cases of patients who received partial nephrectomy from August of 2010 to December of 2015 were retrospectively analyzed;whereas, 3 cases of patients (4.7%) had delayed hemorrhage, including 1 case of male patient and 2 cases of female patients. Then, compared them with patients with no hemorrhage to explore the risk factors for hemorrhage after partial nephrectomy. Results: Three cases of patients showed a large volume of gross hematuria in 7-22 days (the average was 16.3 days) after partial nephrectomy, with blood pressure and hemoglobin (HGB) decreased. 2 cases of patients with hemorrhage were given blood transfusion and conservative treatment, and patients' conditions were improved obviously. The other patient was given super-selective renal artery embolization (SRAE), with renal arteriography indicating the presence of pseudoaneurysm. Hematuria disappeared after surgery. In comparison with the non-hemorrhage group, warm ischemia time was longer in the hemorrhage group, and the difference was of statistical significance (p < .05). Conclusions: Hemorrhage occurred after partial nephrectomy is mostly delayed. Once the type of complications happens, it is required to provide a timely treatment. Super-selective renal artery embolization (SRAE) is a safe and effective treatment method for hemorrhage after partial nephrectomy.

胰十二指肠切除术术后出血列线图预测模型的建立和验证

目的分析胰十二指肠切除术(PD)术后出血的危险因素,构建预测PD术后出血的列线图模型。方法回顾性分析2017年1月—2023年1月494例在南昌大学第二附属医院行PD患者的临床资料。将2017年1月—2020年12月收集的376例患者作为训练集,2021年1月—2023年1月118例患者作为验证集。通过单因素分析、Lasso回归分析和多因素一般Logistic回归分析筛选预测因素并构建列线图预测模型。通过受试者工作特征曲线下面积(AUC)、校正曲线和决策曲线分析(DCA)评估模型的鉴别能力、一致性和临床效果。结果多因素一般Logistic回归分析结果显示,血管重建、术后胰瘘、术后胆瘘、腹腔感染和白蛋白为PD术后出血的独立风险因素(P<0.05)。由上述因素构建列线图预测模型在训练集的AUC为0.870(95%CI:0.820,0.920),验证集AUC为0.799(95%CI:0.691,0.907),提示模型诊断效能较好,在训练集和验证集中绘制出的校正曲线与标准曲线较为接近,提示模型一致性较好。绘制的DCA曲线也表明了明显的正向净收益。结论通过血管重建、术后胰瘘、术后胆瘘和腹腔感染和白蛋白构建的列线图预测模型能够很好识别出PD术后出血的高风险患者,具有很好的临床应用价值。

PCNL肾造瘘管留置对患者术后出血、炎症反应情况的影响研究

目的研究经皮肾镜碎石取石术(PCNL)肾造瘘管留置对患者术后出血、炎症反应情况的影响。方法回顾性分析2017年12月~2021年12月在宁国市人民医院行PCNL的肾结石患者100例,根据患者有无留置肾造瘘管划分为对照组、观察组,各50例,对照组留置肾造瘘管,观察组未留置肾造瘘管。对比两组患者结石清除率、手术时间和住院时间,同时对比两组患者的术后出血情况、术前及术后1 d炎性因子水平变化情况。结果两组患者结石清除率、手术时间比较,差异无统计学意义(P>0.05);对照组住院时间长于观察组[(15.28±4.82)d vs.(11.68±4.56)d],差异有统计学意义(t=3.836,P<0.05);对照组和观察组术后出血发生率(8.00%vs.6.00%)、术后出血量[(221.47±42.58)ml vs.(215.68±39.74)ml]对比差异无统计学意义(t=0.703,P>0.05);术后1 d,两组患者的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平均高于术前,且对照组术后1 d的CRP、TNF-α、IL-6水平分别为(23.17±3.74)mg L、(11.93±2.27)pg L、(21.85±3.72)pg L,明显高于观察组(20.85±3.6)mg L、(10.75±2.11)pg L、(19.68±3.55)pg L,差异均有统计学意义(t=3.122、2.692、2.984,P<0.05)。结论在PCNL中留置或不留置肾造瘘管均能获得良好的结石清除率,但留置肾造瘘管会延长住院时间,加剧患者术后炎症反应,恢复进程较慢。

奥曲肽在内镜粘合剂D-TH治疗食管和胃静脉曲张中的应用

目的 探讨奥曲肽在内镜粘合剂D -TH治疗食管和胃静脉曲张中的作用。方法 粘合剂D -TH内镜注射治疗前 5h起静脉维持滴注奥曲肽 0 0 2 5mg/h ,术前 2 0′静脉注射冲击量奥曲肽 0 1mg。内镜直视下注射D -TH液治疗肝硬化食管和胃静脉曲张及其出血。结果 D -TH治疗 7例食管和胃静脉曲张破裂急性出血均获即时止血 ,8例食管和胃粗大曲张静脉注射D -TH和硬化剂治疗均无针孔出血。结论 应用奥曲肽有助于食管和胃静脉曲张及其出血的内镜下D -TH硬化治疗 ,术后维持治疗可有效降低再出血率。粘合剂D -TH能有效控制食管和胃静脉曲张出血 。

ICU老年脑出血患者术后谵妄发生情况及危险因素分析

目的分析重症加强护理病房(ICU)老年脑出血患者术后谵妄(POD)发生情况和危险因素。方法回顾性分析2020年1月-2023年1月于新疆医科大学第一附属医院ICU行脑出血手术的80例患者的临床资料,根据患者POD发生情况将其分为POD组(n=34)和无POD组(n=46)。对比POD组和无POD组患者的一般资料,手术时间、麻醉持续时间、术中最低平均动脉压,患者术后低氧血症比例、机械通气比例、术后带管时间和术后格拉斯哥昏迷评分(GCS);采用Logistic回归分析ICU老年脑出血患者发生POD的危险因素;采用ROC曲线分析相关因素对脑出血患者发生POD的预测价值。结果80例ICU老年脑出血患者POD发生率为42.50%(34/80);与无POD组相比,POD组平均年龄更高,平均住院时间、糖尿病例数占比、手术时间、脑出血量、麻醉持续时间、术后低氧血症例数占比、机械通气例数占比和术后带管时间均更高,术中最低平均动脉压和术后GCS评分均更低,差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄过大、术后发生低氧血症、GCS评分过低和脑出血量过多是老年ICU脑出血患者发生POD的危险因素(P<0.05)。ROC曲线分析显示,年龄(AUC=0.779)、术后低氧血症(AUC=0.734)、GCS评分(AUC=0.781)和脑出血量(AUC=0.711)均能较好的预测脑出血患者POD的发生情况(P<0.05)。结论年龄过大、术后发生低氧血症、GCS评分过低和脑出血量过多均可能促使ICU老年脑出血患者发生POD。

脊柱术后脑脊液漏伴颅内出血1例报告并文献复习

脑脊液漏是脊柱手术常见并发症,发生率为1.6%~16.0%^([1])。脊柱术后并发椎动脉出血^([2])、颅内血肿等较为少见。术后并发颅内出血发生率为0.4%~1.7%^([3]),其常见症状有头痛、恶心、呕吐、意识障碍进行性加深、神经功能障碍和癫痫等,可引起严重后果,症状和严重程度与出血速度和出血量相关^([4-5])。昆明医科大学第二附属医院于2019年7月23日收治脊柱术后脑脊液漏并发颅内出血患者1例,现将诊疗过程报告如下。

胰十二指肠切除术后胰瘘及胰瘘合并出血的预防及治疗策略

目的探讨胰十二指肠切除术后胰瘘及胰瘘合并出血的预防及治疗策略。方法选取广东省人民医院自2019年8月至2022年12月收治的90例拟行胰十二指肠切除术的患者为研究对象。根据是否发生术后胰瘘将患者分为术后胰瘘组(n=35)与术后无胰瘘组(n=55);根据是否合并出血将35例术后胰瘘患者分为胰瘘合并出血组(n=10)与胰瘘无出血组(n=25)。采用χ^(2)检验或Fisher精确检验进行单因素分析,有统计学差异的变量进一步行逐步回归变量筛选,多因素logistic回归分析确定发生胰瘘和术后胰瘘合并出血的独立危险因素。结果90例患者均顺利完成胰十二指肠切除术,术后胰瘘发生率为38.9%(35/90)。两组患者胰管直径(P=0.013)、术中失血量(P=0.045)、吻合方式(P=0.045)、残余胰腺质地(P=0.010)比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,胰腺质地软、胰腺导管直径<3 mm、术中出血量≥300 mL以及胰肠吻合方式为胰十二指肠切除术后胰瘘的独立危险因素。在发生术后胰瘘的患者中,多因素logistic回归分析结果显示,胰瘘量>100 mL/d、术后胰瘘持续时间>7 d是胰十二指肠切除术后胰瘘合并出血的独立危险因素。结论胰十二指肠切除术后胰瘘的发生风险较高,重视关注术前胰管直径及规范化判断胰腺质地,有助于预防术后胰瘘。术中仔细止血,尽量避免术后早期出血,可以降低术后B、C级胰瘘的发生率。胰瘘患者当胰瘘量>100 mL/d、术后胰瘘持续时间>7 d时要警惕出血的发生。